Abstract：
BACKGROUND: Trigeminal schwannomas (TSs) are intracranial tumors that can cause significant brainstem compression. TS resection can be challenging because of the risk of new neurologic and cranial nerve deficits, especially with large (≥ 3 cm) or giant (≥ 4 cm) TSs. As prior surgical series include TSs of all sizes, we herein present our clinical experience treating large and giant TSs via microsurgical resection.
METHODS: This was a retrospective, single-surgeon case series of adult patients with large or giant TSs treated with microsurgery in 2012-2023.
RESULTS: Seven patients underwent microsurgical resection for TSs (1 large, 6 giant; 4 males; mean age 39 ± 14 years). Tumors were classified as type M (middle fossa in the interdural space; 1 case, 14%), type ME (middle fossa with extracranial extension; 3 cases, 43%), type MP (middle and posterior fossae; 2 cases, 29%), or type MPE (middle/posterior fossae and extracranial space; 1 case, 14%). Six patients were treated with a frontotemporal approach (combined with transmastoid craniotomy in the same sitting in one patient and a delayed transmaxillary approach in another), and one patient was treated using an orbitofrontotemporal approach. Gross total resection was achieved in 5 cases (2 near-total resections). Five patients had preoperative facial numbness, and 6 had immediate postoperative facial numbness, including two with worsened or new symptoms. Two patients (28%) demonstrated new non-trigeminal cranial nerve deficits over mean follow-up of 22 months. Overall, 80% of patients with preoperative facial numbness and 83% with facial numbness at any point experienced improvement or resolution during their postoperative course. All patients with preoperative or new postoperative non-trigeminal tumor-related cranial nerve deficits (4/4) experienced improvement or resolution on follow-up. One patient experienced tumor recurrence that has been managed conservatively.
CONCLUSIONS: Microsurgical resection of large or giant TSs can be performed with low morbidity and excellent long-term cranial nerve function.
METHODS: This was a retrospective, single-surgeon case series of adult patients with large or giant TSs treated with microsurgery in 2012-2023.
RESULTS: Seven patients underwent microsurgical resection for TSs (1 large, 6 giant; 4 males; mean age 39 ± 14 years). Tumors were classified as type M (middle fossa in the interdural space; 1 case, 14%), type ME (middle fossa with extracranial extension; 3 cases, 43%), type MP (middle and posterior fossae; 2 cases, 29%), or type MPE (middle/posterior fossae and extracranial space; 1 case, 14%). Six patients were treated with a frontotemporal approach (combined with transmastoid craniotomy in the same sitting in one patient and a delayed transmaxillary approach in another), and one patient was treated using an orbitofrontotemporal approach. Gross total resection was achieved in 5 cases (2 near-total resections). Five patients had preoperative facial numbness, and 6 had immediate postoperative facial numbness, including two with worsened or new symptoms. Two patients (28%) demonstrated new non-trigeminal cranial nerve deficits over mean follow-up of 22 months. Overall, 80% of patients with preoperative facial numbness and 83% with facial numbness at any point experienced improvement or resolution during their postoperative course. All patients with preoperative or new postoperative non-trigeminal tumor-related cranial nerve deficits (4/4) experienced improvement or resolution on follow-up. One patient experienced tumor recurrence that has been managed conservatively.
CONCLUSIONS: Microsurgical resection of large or giant TSs can be performed with low morbidity and excellent long-term cranial nerve function.
摘要：
背景：三叉神经鞘瘤（TS）是颅内肿瘤，可引起明显的脑干压迫。TS切除可能是具有挑战性的，因为新的神经系统和颅神经缺陷的风险，特别是大（≥3厘米）或巨大（≥4厘米）TSs。由于先前的手术系列包括各种尺寸的TS，我们在此介绍我们通过显微外科手术切除治疗大型和巨大TS的临床经验.
方法：这是一个回顾性研究，2012-2023年接受显微外科手术治疗的大型或巨型TS成人患者的单外科医生病例系列。
结果：7例患者接受了TSs的显微外科手术切除（1例，6个巨人；4个男性；平均年龄39±14岁）。肿瘤分类为M型（硬膜间隙中窝；1例，14%），ME型（中窝颅外延伸；3例，43%），MP型（中、后窝2例，29%），或MPE型（中/后颅窝和颅外间隙；1例，14%)。6例患者接受额颞入路治疗（一名患者在同一坐位中结合经乳突开颅术，另一名患者采用延迟的经上颌入路），1例患者采用眶额颞入路治疗。5例（2例几乎全部切除）获得了全部切除。5例患者术前面部麻木,术后立即出现面部麻木，包括两个有恶化或新症状的。在平均22个月的随访中，有两名患者（28％）出现了新的非三叉神经颅神经缺陷。总的来说,80％的术前面部麻木患者和83％的面部麻木患者在术后过程中出现改善或消退。所有术前或术后新出现的非三叉神经肿瘤相关颅神经缺陷（4/4）的患者在随访中都有改善或消退。一名患者经历了保守治疗的肿瘤复发。
结论：大型或巨大TSs的显微手术切除可以降低发病率和良好的长期颅神经功能。
方法：这是一个回顾性研究，2012-2023年接受显微外科手术治疗的大型或巨型TS成人患者的单外科医生病例系列。
结果：7例患者接受了TSs的显微外科手术切除（1例，6个巨人；4个男性；平均年龄39±14岁）。肿瘤分类为M型（硬膜间隙中窝；1例，14%），ME型（中窝颅外延伸；3例，43%），MP型（中、后窝2例，29%），或MPE型（中/后颅窝和颅外间隙；1例，14%)。6例患者接受额颞入路治疗（一名患者在同一坐位中结合经乳突开颅术，另一名患者采用延迟的经上颌入路），1例患者采用眶额颞入路治疗。5例（2例几乎全部切除）获得了全部切除。5例患者术前面部麻木,术后立即出现面部麻木，包括两个有恶化或新症状的。在平均22个月的随访中，有两名患者（28％）出现了新的非三叉神经颅神经缺陷。总的来说,80％的术前面部麻木患者和83％的面部麻木患者在术后过程中出现改善或消退。所有术前或术后新出现的非三叉神经肿瘤相关颅神经缺陷（4/4）的患者在随访中都有改善或消退。一名患者经历了保守治疗的肿瘤复发。
结论：大型或巨大TSs的显微手术切除可以降低发病率和良好的长期颅神经功能。
